CM5570 Dealing With Co-Morbid Psychiatric Conditions

REPATRIATION COMMISSION GUIDELINES

These Guidelines are not directives and should not be used as a substitute for the proper application of the law to the particular circumstances of each case.

The Guidelines set out the Repatriation Commission's position on investigating and determining claims involving more than one psychiatric diagnosis. They are based on the words of the legislation. The Guidelines indicate the way in which the Commission believes the legislation should be applied.

DEALING WITH CO-MORBID PSYCHIATRIC CONDITIONS

Background

A recent examination of the files of veterans with psychiatric disabilities showed that the treatment of co-morbid psychiatric conditions is not consistent across State Offices.

The Repatriation Commission has directed that policy advice clarifying the method of dealing with co-morbid psychiatric conditions be circulated to its delegates.

The Issues

The examination of cases with co-morbid psychiatric conditions highlighted two main areas of concern relating to possible subsequent eligibility for Special Rate consideration:

Entitlement issues relating to the application of S24(1)(c) of the VEA which deals with the 'alone' test; and

Assessment issues relating to S24(1)(a)(i), which specifies the minimum degree of service-related incapacity which must exist before Special Rate pension can be granted.

Entitlement issues

A veteran may submit a claim for a specific psychiatric condition (eg PTSD) or for the more general 'emotional and behavioural disorder'.

In most cases, the claimed condition has not yet been diagnosed by a clinical psychiatrist in accordance with the “Diagnostic Guidelines for Psychiatric Assessment and Reports for the Department of Veterans' Affairs”.

The veteran is then sent to a clinical psychiatrist for diagnosis and assessment of his psychiatric condition.

The psychiatrist frequently diagnoses more than one psychiatric condition, which may or may not include the original claimed condition. For example, a veteran who claims for PTSD may be diagnosed with PTSDplusdepressive disorderplusalcohol abuse.

In all cases where more than one psychiatric disorder is diagnosed, the VEA requires that each diagnosed condition BE INVESTIGATED AND DETERMINED SEPARATELY.

This investigation and determination should be carried out in accordance with Departmental Guidelines as set out in “The Second Opinion Protocol – Administrative Processes – Psychiatric Cases”.

If this approach isnottaken, in any subsequent consideration of eligibility for an Above General Rate pension it may be difficult to make due allowance for the 'alone' test in S24(1)(c) of the VEA and a decision to grant an Above General Rate pension may be made unlawfully.

Assessment Issues

It can happen that in cases where a veteran is diagnosed with multiple psychiatric conditions,not all of the diagnosed psychiatric conditions are acceptedas being causally related to VEA service.

In these (admittedly rare) cases, the impairment assessment from the diagnosing psychiatrist may only reflect the veteran's overall psychiatric impairment and an estimation of the relative contribution of each condition may not be provided.

For example, in one case a veteran with no physical disabilities ceased work due to his psychiatric condition. This was subsequently diagnosed as 3 separate conditions. After all 3 were rejected at the primary level, the VRB accepted one psychiatric condition but rejected the other two. The psychiatrist had assessed the overall psychiatric impairment without specifying the relative contribution of each of the 3 co-morbid conditions, and this overall impairment rating was used to assess his eligibility for Special Rate consideration. It is not clear that had the total impairment been attributed to each of the 3 conditions, the veteran would have been granted pension at the Special Rate.

In cases where a veteran has both accepted and non-accepted psychiatric conditions, the total psychiatric impairment assessment should be apportioned appropriately in consultation with the diagnosing and/or assessing psychiatrist.

About CLIK

The Consolidated Library of Information and Knowledge (CLIK) contains all the legislative, policy and reference material used by DVA staff in providing service to the clients of the Department of Veterans' Affairs.

Rehabilitation

Disclaimer

Information provided on this website is for general information and on the understanding that the Australian Government is not providing professional advice on a particular matter.

While we make every effort to ensure that the information on this site is accurate and up to date we accept no responsibility whether expressed or implied for the accuracy, currency and completeness of the information.

Before relying on the material you should independently check its relevance for your purposes, and obtain any appropriate professional advice.

For reasons of succinctness and presentation, the information provided on this website may be in the form of summaries and generalisations, and may omit detail that could be significant in a particular context, or to particular persons.

Important legislative change

Please be aware that Parliament has recently passed a new Act that will replace the Safety, Rehabilitation and Compensation Act 1988 (SRCA) for current and former members of the Australian Defence Force (ADF) with conditions linked to service prior to 1 July 2004.

The new Act, titled the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA), will have the same eligibility requirements and provide the same benefits for current and former members of the ADF with compensation coverage under the SRCA. The DRCA will also apply to new claims the Department receives from current and former ADF members with injuries, diseases, deaths, losses or damages resulting from ADF employment prior to 1 July 2004.

The DRCA commenced operation on 12 October 2017.

As a result of this change, the Department is updating its published information, including hardcopy and website content, including CLIK. While this process is well underway, it will take some time before all changes are complete. In the meantime, references within CLIK to the Safety, Rehabilitation and Compensation Act 1988 or SRCA should now generally be understood to be references to the new DRCA Act (with the exception of intended historical references to SRCA). It is important to note that the same provision references (i.e., sections, subsections and paragraphs) from the SRCA have been retained in the DRCA.

Again, while the Department makes every effort to ensure that the information on this site is accurate and up to date and all necessary changes will be made as soon as practicable, the above disclaimer notice is of particular importance to those members whose circumstances may be affected by this legislative change. We appreciate your patience during this change process.